PCNA IMMUNOSTAINING COMBINED WITH AGNOR STAINING IN ESOPHAGEAL SQUAMOUS-CELL CARCINOMA TO IDENTIFY PATIENTS WITH A POOR-PROGNOSIS

Immunostaining of the proliferating cell nuclear antigen (PCNA) provid es important information about cell kinetics and is easily performed o n routinely obtained formalin-fixed, paraffin-embedded materials. We r eport herein the results of a retrospective study on PCNA staining in esophageal cancer undertaken to determine its significance. As this st udy indicated that immunoreactivity was preserved in specimens fixed w ithin 24 h, only 31 specimens from surgical patients were available fo r this investigation. The mean PCNA index of the patients without inva sion to the adventitia (35.7 +/- 17.9) was significantly lower than th at of those with invasion to the adventitia or neighboring structures (49.7 +/- 14.5), while the PCNA index did not correlate with other cli nicopathologic parameters such as histologic type, lymph node metastas es, or prognosis. However, when an analysis of PCNA staining was combi ned with an analysis of argyrophilic nucleolar organizer region (AgNOR ) staining, a correlation with prognosis was found. In fact, seven pat ients with a high PCNA index (greater-than-or-equal-to 44) and AgNOR c ount (greater-than-or-equal-to 6) had a significantly poorer prognosis than the remaining 22 (P = 0.0014), and six of these seven patients d ied within 2 years. These results indicate that this combined evaluati on may be useful for the identification of patients with a poor progno sis among those undergoing surgery for esophageal squamous cell carcin oma.